In order to ensure that patients in COVID-19 will not be affected by hospitalization expenses, the document stipulates that the policy of "Class B and Class A management" will continue to be implemented for hospitalized patients in COVID-19, and the hospitalization expenses of patients in COVID-19 will be fully guaranteed. COVID-19 patients in all medical institutions, in line with the Ministry of Health's COVID-19 diagnosis and treatment program of hospitalization medical expenses, by the basic medical insurance, serious illness insurance, medical assistance and other provisions to pay, personal burden by financial subsidies. This policy is based on the admission time of COVID-19 patients and will be implemented until March 3, 20231.
Two, about the cost of outpatient and emergency patients in COVID-19.
In order to ensure that patients in COVID-19 can get medical services in time at the initial stage of infection, the document requires that medical insurance should be strengthened to support grassroots medical institutions such as rural areas and urban communities, and grassroots medical institutions should be encouraged to supply COVID-19 therapeutic drugs in the medical insurance drug list (including provincial temporary supplements), and special guarantee should be implemented for outpatient and emergency expenses of designated medical institutions (secondary and below medical institutions) COVID-19 and patients with suspected symptoms. The outpatient and emergency expenses (within the scope of medical insurance catalogue) related to COVID-19's treatment incurred by the insured patients in the designated medical institutions of primary medical insurance (secondary and below medical institutions), and there is no deductible line and capping line for medical insurance reimbursement, and the reimbursement ratio is 80%, which will be implemented until March 3, 20231. The expenses incurred by insured patients in outpatient and emergency departments of other medical institutions in COVID-19 shall be reimbursed according to the medical insurance policies for other Class B infectious diseases.
Three, about COVID-19 patients medication safety.
In order to adapt to the current epidemic situation, meet the needs of patients in COVID-19, and implement the national temporary payment policy for novel coronavirus drugs in COVID-19's diagnosis and treatment plan, according to the actual situation in our province, 26 COVID-19 drugs will be temporarily included in the scope of medical insurance fund payment, and will be implemented until March 3, 20231day.
Four, about COVID-19 patients online diagnosis and treatment.
In order to ensure that patients in COVID-19 can receive timely treatment, the local health department should promptly publish the list of medical institutions providing "internet plus" medical services. For the first Internet consultation service allowed by the industrial department of COVID-19, mobile payment and settlement services of medical insurance will be provided for patients with COVID-19-related symptoms and meeting the guidelines for family treatment of COVID-19-infected people. The medical insurance department supports the online first-visit medical service price policy according to the principle of online and offline consistency, and the reimbursement standard is consistent with offline. The related symptom follow-up service in COVID-19 is still implemented according to the current Internet follow-up reimbursement policy.
Five, about reducing the cost of treatment in COVID-19 to meet the needs of clinical treatment.
The document calls for continuing to do a good job in price negotiation or negotiation, centralized procurement, online procurement, filing procurement and price monitoring. Drugs needed for the treatment of patients in COVID-19, thus reducing the treatment cost of patients in COVID-19. At the same time, the price items of medical services such as high-flow humidified oxygen inhalation therapy, prone position ventilation therapy, first visit to COVID-19, and internet plus were added, and they were included in the payment scope of medical insurance fund according to regulations.
Six, about improving the ability of medical security.
The document requires all localities to speed up the implementation of policies, which not only reasonably reduces the burden on the masses, but also ensures the safety and sustainability of the fund. Strengthen the supervision of the special security fund for outpatient and emergency departments, and guide medical institutions and medical personnel to use drugs rationally and check reasonably. It is necessary to establish a risk early warning mechanism for the operation of medical insurance funds, and if necessary, make overall adjustments between the medical insurance for employees in the region and the medical insurance funds for urban and rural residents. The medical insurance fund is subsidized by the cities and counties as a whole, and the specific sharing method is determined by the cities themselves.
Seven, about medical insurance service management.
The document requires all localities to strengthen policy training for handling personnel, optimize medical insurance and convenience services, and do a good job in connecting old and new policies. It is necessary to speed up the application of medical insurance electronic certificate, optimize and expand the functions of medical insurance network hall and medical insurance information platform, and effectively improve the level of medical insurance information service. Continue to do a good job in drug security for patients with chronic diseases, and include long-term prescription drugs for chronic diseases issued by medical institutions into the scope of medical insurance payment according to regulations. All localities should, according to the needs, sign temporary special agreements with non-medical insurance designated medical institutions that have the ability of diagnosis and treatment in COVID-19 and can directly settle online, strengthen the management of the agreements, and guide all kinds of medical institutions to do a good job in the collection and uploading of relevant diagnosis and treatment settlement information in COVID-19. At the same time, optimize the medical insurance settlement process, speed up the disbursement of funds, and ensure that policy implementation is not affected by the medical insurance settlement problem. Give full play to the handling power and promote the sinking of services. City and county agencies should do a good job in the publicity and mobilization of insurance, cooperate with relevant departments to do a good job in health promotion in rural and urban communities, popularize knowledge of epidemic prevention and control, raise people's awareness of self-protection, and earnestly ensure that medical insurance management is not relaxed and medical insurance handling services are not interrupted.
Eight. Responsibilities of relevant departments
The document requires all relevant departments to improve their political stance, strengthen coordination and linkage, earnestly perform their duties, and ensure that relevant policies on medical security are put in place. The medical insurance department is responsible for the audit and settlement of related expenses and strengthening fund supervision; The financial department is responsible for timely disbursement of financial subsidies; The health department is responsible for guiding medical institutions to do a good job in the identification, information registration and data uploading of COVID-19 patients.